Educator Update - Summer 2019

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THE HANDS ON APPROACH TO GLOVES-OFF PRECEPTING perfect at their skills. In fact, I don’t really even expect them to be good. I work with them on every single skill, until I believe they have gained enough proficiency that they only need practice. A few of my students have been extremely hard on themselves when they miss an IV. If there’s something I’ve noticed that they can improve on, or any tricks and tips I can offer, I will. But oftentimes, this frustration comes when the student has already been starting IVs for a while, and it’s just a bad streak. I have had students get visibly and vocally frustrated, use profanity in front of the patient or family members, or be completely distracted for the rest of the transport. I usually shoot them a “look” to let them know that their behavior is unacceptable, and then we discuss the incident after we transfer care. During this conversation, I don’t yell at them or speak to them like a child. I give them some advice on how to let it roll off their back so they can focus on the rest of the transport. I don’t badger them, and like any conversation we have, after it’s over, it’s completely over- unless my student wants to discuss it more. This issue alone is a big reason for letting the student just focus on their skills for this phase. Once the student shows proficiency in their ALS skills, and the ability to control their emotions if they don’t succeed at a skill, we begin Phase Four. PHASE FOUR: INTEGRATION This is by far the toughest phase for any student. Most students find the transition to “doing and talking” at the same time very difficult. This phase is led by your student’s comfort level and simply guided by you. At the beginning of this phase, you should take a look at how much time your student has left in class before they begin national testing and assess how much progress needs to be made to meet that deadline. The majority of my students arrive at this phase at around the halfway point in class (around month 6). Phase Four is when our students become paramedics. The student combines what they learned in Phase Two regarding assessments with their skills from Phase Three. Because they are expected to do both at this point, I will act as a second paramedic for ALS skills only if necessary. Otherwise, I will act as a basic provider. This is the first phase that you’ll really back off and start handing the reins to your student- or at least let them hold the reins too. But, I do not ‘throw my student to the wolves’ during this phase. 14 | Educator Update | www.naemse.org During the initial assessment and gathering a history at the scene, I allow the student to do the majority of the assessment. I will insert my own questions if I feel they need to be asked. By continuing to engage, my student can learn from those questions and assessment techniques, which are often learned best by watching other providers. As we load the patient into the ambulance, I always have a quick 10-second conversation with my student. “What’s going on with this patient?” and “What is your plan?” I offer my coaching at that time if they need it, maybe a couple of quiz-style questions, and then I proceed with their acceptable treatment plan. I’m still reviewing, quizzing, and teaching during the run when appropriate. I still obtain patient information, document vitals and procedures as the student is performing them. I encourage the student to formulate and document their own primary impression, chief complaint, and of course, the narrative. The patient care report gradually becomes their responsibility, based on how they are advancing. I will call report if the student is tied up with the patient, because patient care is the student priority. I try hard to make it possible for the student to call report, when appropriate. Talking and doing is a skill the student must be developing at this point. As we approach the hospital, I ask the student what they are going to say when transferring care to the ER staff. After transferring care, I always ask the student if they have any questions, and my students should always ask if there is anything they could do better. Have the conversation about what to do better if you need to, but do so in an atmosphere of constructive criticism and encouragement. Always talk about the positives if you have negatives to critique. This phase requires an encouraging preceptor, but one who is not afraid to perfect this student. Our goal is excellence. The only way to obtain excellence is to constantly critique and improve, but keep a balance with positive feedback. Phase Four ends with a competent and mostly confident student who comfortably initiates aggressive assessment and treatment. This student does not miss things on “cookie-cutter” runs. Your student accepts criticism well and asks for ways to improve. A student who is ready to move on from Phase Four connects the why to the what; they understand the physiology
THE HANDS ON APPROACH TO HANDS-OFF PRECEPTING behind our treatment. Your student will be motivated to learn more and continue training. Your student will think almost as fast as you on complex runs. The student is able to write the majority of the patient care report, but prioritizes it correctly. A student who has successfully completed Phase Four manages time well in the back of the ambulance, balancing on-scene treatment and assessment with en route modalities. The student is starting to grasp scene management- which can be a very difficult development for those with little experience as an EMT, but we will continue to master this during the final phase. PHASE FIVE: YOU ARE THE PARAMEDIC- THE BIG PICTURE Phase Five is the hardest phase for preceptors. This is when we hang out in the background, and let the student take the reins. You must be extremely particular during the previous four phases- so you are comfortable letting go when it’s time. During Phase Five, I make a very conscious effort to not assist on assessment (unless the student is missing something HUGE- i.e.: time last seen normal for a stroke patient), and to allow the student to process through their treatment plan without coaching. Our job at this point should be perfecting our student, chiseling a great product, and making sure they don’t harm themselves or the patient. The student will utilize the crew EMT as their EMT. I am merely an observer, occasionally helping out logistically when it makes sense. (e.g.: carrying equipment, placing a blood pressure cuff, performing as directed by my student if the patient’s condition deteriorates during transport, providing advice on destination choices if absolutely necessary, and being available for consult on out of the ordinary runs). During the beginning of phase five, I still wear gloves. The student is writing the entire patient care report at this point. The student is calling for additional resources should they deem it necessary. They are choosing the transport destination, and unless I find it wildly inappropriate, that is their choice to make. This phase goes very well for most students who have followed this system and is extremely rewarding for you as the preceptor to see your student develop into a paramedic based on your precepting. By the end Phase Five, I have removed my gloves and I sit in the captain’s chair belted in. I am literally there only to ensure that the student does not neglect care in a way that would harm the patient or the patient outcome. Despite the amount of experience and training you have given your student, they are still going to run into unfamiliar situations. You are there during Phase Five if they need to “phone a friend.” During Phase Five, I do not take over patient care reports. I’m here for questions and am more than happy to help, but it is their responsibility. I do not prompt unless it is something that will directly impact patient care or anyone’s safety on scene. I do not stop teaching after the run and I do not stop quizzing the student. I do not give report or add to the report unless student has missed something that is detrimental to transfer of care. Upon completion of Phase Five, you should have a Paramedic on your hands. You should have a partner that you feel comfortable working with. You should trust your partner enough to say, “get access,” or “you got the airway?” and know your patient is in the best hands possible. It is our responsibility to our patients to create outstanding, well-rounded, excellent care providers. ADDITIONAL COMPONENTS OF THE SYSTEM Equipment Checks: Each ambulance should be checked daily- we know that. I encourage our preceptors to use this time as a “drill and learn” scenario. You should touch almost every piece of equipment and use this as an opportunity to review with and teach your student. At first this will be a conversation; then it will become a quiz type interaction. Push your student to memorize, learn more, and think outside the box. Work through scenarios in which you would use the equipment and allow the student to ask questions and formulate their treatment plan. By Phase Five, you should have created a student that you can trust to complete this check the right way, every single time. Check-ins: Check-ins are sit-down conversations with your student. Go to the office or a small conference room, where you can have a confidential, frank conversation. By making these feel “official,” the student will take them more seriously, and I think we get better www.naemse.org | Educator Update | 15
Page 1 and 2: The Hands On Approach to Gloves-Off
Page 3 and 4: IN THIS ISSUE National Association
Page 5 and 6: NAEMSE Symposium 2019! by Stephen P
Page 7 and 8: A MATTER OF DEGREES: THE CASE FOR D
Page 9 and 10: A MATTER OF DEGREES: THE CASE FOR D
Page 11 and 12: WHY YOU SHOULD JOIN You Belong You
Page 13 and 14: THE HANDS ON APPROACH TO GLOVES-OFF
Page 15: THE HANDS ON APPROACH TO GLOVES-OFF
Page 19 and 20: THE HANDS ON APPROACH TO HANDS-OFF
Page 21 and 22: SAVE THE DATES! 25thEDUCATOR SYMPOS

Educator Update - Summer 2019

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